Tag: PLIF

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Development and Validation of Interpretable Machine Learning Models Incorporating Paraspinal Muscle Quality to Predict Cage Subsidence Risk Following Posterior Lumbar Interbody Fusion

Spine 2025;50:1375–1385

This multicenter retrospective study developed and validated an interpretable LightGBM machine learning model incorporating paraspinal muscle quality and bone metrics to accurately predict cage subsidence risk after PLIF. Key risk factors included lower psoas muscle index, higher fat infiltration, reduced bone density, and suboptimal cage parameters.

• A machine learning model (LightGBM) was developed to predict cage subsidence risk after PLIF, achieving high accuracy (AUC 0.9752, 92% accuracy, F1 score 0.92).

• Key independent risk factors include lower psoas muscle index (PMI), higher fat infiltration (FI), reduced bone density (HU value, VBQ), suboptimal cage position/height, and greater postoperative changes in intervertebral height (IH) and segmental angle (SA).

• Paraspinal muscle quality was a major contributor; removing muscle indicators reduced model accuracy substantially.

• Patients with cage subsidence had poorer paraspinal muscle and bone quality compared to those without subsidence.

• The model was externally validated and deployed as a web-based tool for real-time, individualized clinical risk assessment.

• Findings support personalized surgical planning and risk mitigation strategies for PLIF patients.

• The study emphasizes a multifactorial approach, integrating skeletal, muscular, and surgical parameters for optimal prediction.

• Limitations include retrospective design, use of a single cage type, and lack of comorbidity indices; further prospective studies are needed.

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Are there differences in the reoperation rates for operative adjacent-segment disease between ALIF+PS, PLIF+PS, TLIF+PS, and LLIF+PS? An analysis of a cohort of 5291 patients

J Neurosurg Spine 40:733–740, 2024

Biomechanical factors in lumbar fusions accelerate the development of adjacent-segment disease (ASD). Stiffness in the fused segment increases motion in the adjacent levels, resulting in ASD. The objective of this study was to determine if there are differences in the reoperation rates for symptomatic ASD (operative ASD) between anterior lumbar interbody fusion plus pedicle screws (ALIF+PS), posterior lumbar interbody fusion plus pedicle screws (PLIF+PS), transforaminal lumbar interbody fusion plus pedicle screws (TLIF+PS), and lateral lumbar interbody fusion plus pedicle screws (LLIF+PS).

METHODS A retrospective study using data from the Kaiser Permanente Spine Registry identified an adult cohort (≥ 18 years old) with degenerative disc disease who underwent primary lumbar interbody fusions with pedicle screws between L3 to S1. Demographic and operative data were obtained from the registry, and chart review was used to document operative ASD. Patients were followed until operative ASD, membership termination, the end of study (March 31, 2022), or death. Operative ASD was analyzed using Cox proportional hazards models.

RESULTS The final study population included 5291 patients with a mean ± SD age of 60.1 ± 12.1 years and a followup of 6.3 ± 3.8 years. There was a total of 443 operative ASD cases, with an overall incidence rate of reoperation for ASD of 8.37% (95% CI 7.6–9.2). The crude incidence of operative ASD at 5 years was the lowest in the ALIF+PS cohort (7.7%, 95% CI 6.3–9.4). In the adjusted models, the authors failed to detect a statistical difference in operative ASD between ALIF+PS (reference) versus PLIF+PS (HR 1.06 [0.79–1.44], p = 0.69) versus TLIF+PS (HR 1.03 [0.81–1.31], p = 0.83) versus LLIF+PS (HR 1.38 [0.77–2.46], p = 0.28).

CONCLUSIONS In a large cohort of over 5000 patients with an average follow-up of > 6 years, the authors found no differences in the reoperation rates for symptomatic ASD (operative ASD) between ALIF+PS and PLIF+PS, TLIF+PS, or LLIF+PS.

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Posterior Lumbar Interbody Fusion: Comparison of Single Intervertebral Cage and Single Side Pedicle Screw Fixation versus Bilateral Cages and Screw Fixation

Minim Invas Neurosurg 2009; 52: 132 – 136. DOI 10.1055/s-0029-1224097

Introduction: The efficacy and economy of an alternative sparing method for posterior lumbar interbody fusion (PLIF) using a single cage fixed with pedicle screws placed on a single side (SS group, n = 22) was compared to that of a standard bilateral protocol using two cages and pedicle screws placed bilaterally (BL group, n = 15).

Methods: All PLIFs were non-compensation cases done at a single level by a single surgeon and were similar in most background characteristics. Significant differences were not found between the two groups in fusion rates, complications or in 2-year prospectively collected outcomes including percent improvement in back and leg pain (visual analog scales) and the Oswestry disability index.

Results: Perioperative results significantly favored the SS group: BL patients lost 81 % more blood, used 74 % more time for surgery, stayed in hospital 1.7 days longer, and the hospital-related cost per procedure was twice as high. Currently, the SS procedure typically averages less than 1 hand blood loss less than 50 mL. In summary, the BL and SS groups had similar outcomes while the SS procedure provided substantially superior efficiency and economy.

Conclusion: In conclusion, the results of this retrospective comparative level III study warrant further studies on the SS protocol which may lead to the adoption of this minimally invasive protocol in the standard practice of PLIF in selected cases.

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